Arizona CPS early investigations critical

Reformers: First response to abuse cases crucial

The preliminary investigation into allegations of child abuse and neglect is considered the most critical piece of the child-protection system.

Those very first steps in the process, experts say, are potentially life-or-death decisions that can set the course for the case and determine the future of the child and family. Caseworkers and supervisors with Child Protective Services must decide whether to pursue an investigation, whether to notify police or whether to remove a child from a home.

Arizona policy makers have zeroed in on the front end of CPS -- when the first report of abuse or neglect is made -- after a rash of high-profile child deaths last summer put a spotlight on the agency.

Maricopa County Attorney Bill Montgomery, who chaired the governor's Child Safety Task Force, placed much of the blame on investigations, saying CPS workers "don't remove children that they should, and those children wind up dead."

But child deaths can happen no matter what the level of response. Adults have killed or seriously injured dozens of children after joint investigations between police and CPS. Children have died after CPS and community agencies offered services to families in what were considered low-priority cases. They've died after authorities have removed the children from parents and later returned them. And they've died in foster care.

CPS not only investigates suspected abuse and neglect, but also coordinates services for families and monitors children in the system. But policy makers and law-enforcement and child-welfare officials have paid significant attention to improving the initial investigative phase and better identify chronic cases that may fly under the radar.

Montgomery wants a specially trained investigative unit within the state Department of Economic Security, which oversees CPS, to bring a keener law-enforcement eye to the most serious cases and prevent others from falling through the cracks. Gov. Jan Brewer and state lawmakers support the proposal.

CPS is streamlining its investigative process with help from an independent consultant and is attempting to increase training and supervision to work through cases more quickly without missing key warning signs.

And a recycled proposal to divert thousands of low-level cases to contracted service providers is getting a new look as federal officials encourage states to develop these two-tiered responses to child abuse and neglect.

But during the task-force hearings late last year it became clear there is no single investigative solution to ensure that Arizona's children aren't victimized by their parents or caregivers. Brewer set up the task force to recommend improvements to the child-welfare system.

"Part of the issue with the investigation of child maltreatment is it's complicated," said Doug Kline, a retired Mesa police commander who ran the Mesa Center Against Family Violence. "But if you don't do it right, you've crippled the case. Any step toward improving that initial look is going to be a good thing."

Challenges

CPS investigators, administrators and police say the easiest decisions tend to involve the most severe cases, such as a hospitalized shaken baby. The tricky investigations, they say, are less obvious cases they may deem low risk but can and do become child fatalities.

"Usually the cases that are missed are the ones that aren't glaring. If they're at the hospital with broken bones, you pretty much know what the deal is," said Anna Arnold, who retired from DES in 2002 as assistant director for the Division of Children, Youth and Families.

In Arizona and nationally, at least two-thirds of CPS investigations stem from neglect allegations, not abuse, and an equal percentage are classified as low or potential risk situations. In this vast gray area, any danger to children may not appear imminent, and the family's problems, as well as the potential for criminal charges, are harder to respond to.

CPS units receive nearly 100 new abuse and neglect reports every day, pushing backlogs and caseloads to unprecedented levels. That can compromise the timeliness and thoroughness of initial investigations, which can lead to mistakes or delays that doom criminal prosecution and endanger children. Dozens of workers who recently left CPS say they worried that they could no longer ensure the children's safety.

Caseworkers also face other challenges that eat up time. They must investigate reports that some argue don't belong with CPS at all. Almost every night, they are ferrying teens from juvenile detention to group homes because their parents won't pick them up. CPS also is used as a pawn in custody battles, with hotline workers taking calls from angry spouses complaining about the other parent when there's no real threat.

"Someone has to go out and determine if the allegations are true," CPS investigator Rebecca Wright said.

At the same time, workers and their supervisors say, families have faced more challenges since the recession took hold, from poverty to substance abuse and untreated mental illness. Sweeping program reductions to close budget deficits, beginning in 2008, have reduced or eliminated services that helped families remain stable.

But the investigative challenges are only part of the problem. Most children who died from mistreatment in Arizona never came to the attention of CPS. Seventy children died from abuse or neglect in 2010, including 13 with prior CPS reports and five with open CPS cases, according to the state's Child Fatality Review Program.

The investigation

The initial investigation phase is fairly straightforward, but it requires workers and supervisors to make critical decisions, often in a matter of minutes when the call first comes in and sometimes without key pieces of information, such as interviews with the family.

First, CPS workers on the 24-hour Child Abuse Hotline take a call alleging mistreatment. Sometimes those calls come from the public, such as a worried family member or neighbor, but often from police on the scene or hospital workers who have admitted a child.

Anyone can make a report, but certain people -- including doctors, teachers and others responsible for children -- are required by law to call the hotline if they suspect child abuse or neglect.

Workers answer about half of all calls to the hotline immediately, but some callers can wait from five to up to 45 minutes on hold. Last year, 17 percent of the 144,000 calls were lost before workers could answer them.

Hotline staff, who are trained caseworkers, interview callers. They must decide whether to move the case forward and involve police, and they must determine how urgently a response is needed.

Questions are aimed at determining how well the caller knows the child and family and how recent, chronic and severe the abuse or neglect may be. Workers must meet daily call quotas, so they want to get the information as quickly as possible to move on to the next call.

Based on the interview and background research on the family, including prior CPS reports, the hotline worker decides whether to assign the case to a field unit for investigation or document it as a "communication only" report. About one-third of the calls to the hotline don't become investigations.

If the hotline worker assigns the case, he or she gives it one of four priority levels that determine how quickly an investigator should respond.

The hotline worker also decides whether the allegations rise to the level of criminal conduct, such as assault or child molestation, which requires local law-enforcement agency notification.

About 6 percent of CPS investigations are handled jointly with police.

A field investigator must respond from within two hours to seven days depending on the priority level.

Investigators try to conduct in-person interviews with the children and family, as well as others who may know them. They check court records, medical history and state databases for food stamps, welfare and other services that can show where the family has lived and who has lived with them. The investigation includes an assessment of the home and the overall safety of the children there.

At this point, the CPS worker decides whether there is imminent risk that requires removal of the children. The decision is supposed to be made in consultation with a supervisor. But caseworkers have authority to take temporary custody of children on their own in cases, for example, where there are obvious signs of serious abuse or concerns that a parent may flee with the children.

When there are allegations of criminal abuse or neglect, joint investigations with police are guided by each county's protocols that outline procedures for interviews, medical exams, scene preservation and other aspects of the investigation. Experts consider family-advocacy centers a model for cooperation between agencies, including CPS, medical, police and social-work professionals who investigate and treat child-abuse victims.

Following the initial investigation and safety assessment, CPS investigators decide whether the children are safe.

If so, they can close the case or keep it open so the family can receive services, such as child care or counseling. Eighty percent of neglect and abuse investigations are closed without any further action -- no services provided, no proof that abuse or neglect occurred.

If the child is in danger, the case remains open and is transferred to another CPS caseworker. Particularly when children have been removed, which happens about 10 percent of the time, these cases can last for years.

Officials have targeted the hotline as a key link in the investigations process. Internal DES reviews are focused on reducing the length of time callers are on hold and improving the filtering of calls to weed out the frivolous and catch the most serious cases.

Montgomery argues that the number of joint investigations is too low and says potential criminal cases are missed at the hotline. He wants workers to assign older allegations a higher priority if they involve criminal conduct. Now, state policy requires workers to assign the lowest priority to suspected abuse that happened more than 30 days ago.

A new team

The most significant proposal to address investigative problems would create a 28-member unit staffed by former law-enforcement officials.

The new unit would provide an additional layer of oversight for CPS investigations, housed under DES but separate from CPS. The unit's proposed role has shifted somewhat over the past several months and its particulars remain murky. Differing descriptions have been offered from the Governor's Office, Montgomery and DES, and the House bill that would create the unit. So it's not clear where these new investigators would be deployed or what they would do, though it's doubtful they would take on caseloads and relieve CPS caseworkers of their current responsibilities.

Despite disagreement over details, law-enforcement officials, politicians and child-welfare advocates agree any extra attention to the most serious cases of child abuse and neglect is welcome.

"(The new unit) says that we, the community, take this seriously," said Karen McLaughlin, a former Yavapai County deputy who now runs the Arizona Child and Family Advocacy Network, which represents the state's 15 advocacy centers. "That this is a crime. You can't keep doing this to this little kid."

The challenge, some say, is teasing out which cases merit a closer look and ensuring that the new investigators have the right experience to handle the job.

"Who they pick is absolutely crucial," said Kline, the retired Mesa officer, who also supervised the Mesa police sex-crimes unit. "So many of these cases are so grim. There's only so much of that that regular folks can take."

A draft job description would allow the workers to do everything from screening hotline calls to responding to the highest-priority reports.

Brewer wants investigators to assist CPS units in multidisciplinary family-advocacy centers, like Childhelp in Phoenix and Mesa's Center Against Family Violence, which typically see the most serious abuse and neglect cases, as well as help in other busy offices and conduct training.

House Bill 2721, sponsored by Rep. Eddie Farnsworth, R-Gilbert, and written by Montgomery's office, would require this new unit to respond to all cases where criminal acts are alleged, notify law enforcement and take children into temporary custody if warranted.

Montgomery sees DES investigators taking on a variety of roles while ensuring that law enforcement and CPS work together to successfully prosecute more cases. That will free CPS workers to do more intensive social work, he said.

"(They) can do what (they) came on board to do, which is to help families," Montgomery said. "Someone else is going to be handling the ugly side of what human beings do to children."

Brewer and lawmakers have included $2.3 million in their respective budget proposals next fiscal year to fund the new unit.

Including salaries and benefits, 23 investigators in the new unit would be paid $70,000 a year and four supervisors would earn $80,000 a year, according to legislative-budget analysts.

"We need to have reasonable caseloads so that trained, qualified CPS investigators can assess what's happening with the needs of those families and the safety of those children," said Beth Rosenberg of the Children's Action Alliance and a former CPS administrator. "Caseloads are the foundation for people to do a decent job."

Alternative response

One quick way to reduce caseloads is to divert low-level abuse and neglect reports to community social-service providers and allow investigators to focus on the most serious cases.

Arizona had such a system for about five years, but dropped it amid financial and political pressure.

More recently, DES administrators developed a preliminary proposal to refer more than half of CPS cases to outside agencies for follow-up and services, but it was shelved. The annual price tag was estimated at $26 million, according to internal DES e-mails.

Federal funding is available for states to develop two-tiered or "differential" response systems, which are intended to give caseworkers more time for the most severe cases and encourage other families to accept services absent the stigma of CPS or police involvement.

Twenty states and counties in the U.S. use the two-tiered response, with full-blown investigations reserved for the most severe cases.

"There are people who need to be separated from their children. But they are an extreme minority. So the problem is, what do you do with the rest?" said Gary Siegel, a St. Louis-based public-policy analyst who evaluates child-welfare programs throughout the country. "A police approach isn't effective in a lot of cases."

Arizona created a differential-response system, called Family Builders, in 1997 to address a backlog of uninvestigated abuse and neglect reports. State audits and independent reviews generally found it was at least as effective as CPS in preventing future reports, but the program struggled to monitor costs.

Then-DES Director David Berns disbanded Family Builders as CPS underwent reforms in 2003 following a string of child deaths, declaring the agency would resume investigating 100 percent of child-abuse and neglect allegations.

Part of the challenge was that the non-profit agencies made initial visits and then notified CPS if families rebuffed their efforts, they couldn't locate families or thought the problem was more serious than it first appeared. Two separate CPS units were intended to follow up on those Family Builders cases, but some still fell through the cracks.

Longtime CPS workers also were concerned that social-services agencies lacked the authority and families too easily rejected them. These families were, for the most part, already too troubled to benefit from the kinder, gentler Family Builders approach, they argued.

"People just walked away from the family," said Rosenberg, of the Children's Action Alliance. "We never felt comfortable with that. We thought people should've gone back and made sure children were OK."

Child-welfare experts consider Minnesota the gold standard among jurisdictions with a two-tiered response to child abuse and neglect.

Erin Sullivan Sutton, an assistant commissioner for the Minnesota Department of Human Services, helped implement the program in 20 counties in 2000 and saw it quickly spread to the rest of the state's 87 counties.

"It became pretty infectious," she said. "Social workers really liked their jobs. They were doing social work, helping families and not having to take on a police role. Families were very responsive."

Child-welfare workers conduct the initial investigations, but they send 70 percent of all child-abuse and neglect reports down the social-work track. Child safety has improved since Minnesota implemented the program, Sutton said, and the number of foster children plummeted by nearly 40 percent.

"For us it was a culture change," she said. "Not only did (workers) have to change what they did, but we had to change the image people had about families who were reported to Child Protective Services."

Inside CPS

DES Director Clarence Carter says he welcomes the proposed investigative unit and has begun administrative changes to bring the new workers on board. He says he also is moving forward on several other fronts to improve CPS investigations.

But a stubborn backlog of more than 8,300 cases and the steady stream of new reports are getting in the way.

Change and Innovation Agency, a Kansas City, Mo., consultant, has a $631,000 contract to improve CPS performance from the hotline to investigations to ongoing case management. The company began work in 2010 to streamline investigations as the backlog began building, and its services have since been extended to recommend systemwide improvements.

A new, shorter internal process, which is being tested in three CPS offices, is aimed at reducing the time it takes CPS workers to complete investigations to 40 days from the current average of six months or more. The information-gathering phase is unchanged under the new model, but a slimmed-down form for documenting the information should take 90 minutes to complete, compared with the eight hours of paperwork under the current system.

DES officials are reviewing the results of the new form to ensure that it doesn't compromise child safety and plan to decide in May whether to expand the practice statewide.

In the meantime, the factors that created the backlog still exist, including turnover and caseloads that average two-thirds above state and national standards, and CPS offices are struggling to keep up with piles of paperwork.

That led DES officials earlier this month to call on about 50 administrators, policy analysts, trainers and other central-office staff to take on investigations or assist investigators in the field. Those who haven't handled cases in decades are encouraged to take refresher training courses, and overtime has been approved so they can continue to perform their regular duties.

"We do what we have to do to support our staff and ensure that those kiddos are safe. It's the right thing to do," said Stacy Reinstein, senior policy manager for DES, who will be driving around a caseworker. "We are putting all hands on deck."

It's been a few years since administrators were turned into part-time investigators. While it's not unprecedented, it's a troubling development that highlights how much the agency is struggling, said Rosenberg, the former CPS administrator.

"We're putting Band-Aids on a very critical situation," she said. "If we really care about the protection and safety of children, this is not the way to run Child Protective Services."

Proposed fixes

The state Department of Economic Security and the governor's Child Safety Task Force have proposed several reforms to help Child Protective Services and law-enforcement agencies work more closely together when children are endangered, improve initial screenings so cases are appropriately prioritized and remove bureaucratic barriers that have buried workers under caseloads.

Among the proposals:

Create the Office of Child Welfare Investigations, within DES but separate from CPS, to investigate criminal allegations of abuse and neglect.

Add a third line to the Arizona Child Abuse Hotline for mandated reporters, including doctors, teachers and counselors, and those who are with the child when they're making the call. The hotline currently has a second line for law enforcement.

Improve training for CPS investigators and hotline workers, including forensic interviewing and better recognition of potential criminal abuse or neglect; and add social-work training for police to improve their response to child-welfare calls.

Reduce paperwork for CPS investigators to shorten investigation time or free up more time for interviews and other casework.

Increase front-line supervision for investigators, including documented collaboration on cases, and reduce case backlogs so supervisors aren't working cases themselves.

Use CPS administrators, supervisors and others to help reduce a backlog of more than 8,300 cases, including cases assigned months ago but not yet investigated.

After initial investigation by CPS caseworkers, divert the lowest-risk cases to contracted providers, who would offer case management and social services to children and families.